ID

26298

Descripción

Study ID: 101468/190 Clinical Study ID: SKF-101468/190 Study Title:A 12 Week, Double-Blind, Placebo-Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication: Restless Legs Syndrome This is the Study Conclusion assessment form.

Palabras clave

Versiones (2)
  1. 16/10/17 16/10/17 -
  2. 16/10/17 16/10/17 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

16 de octubre de 2017

DOI

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Licencia

Creative Commons BY-NC 3.0
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Study Conclusion 26072_GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

Inglés

Study Conclusion 26072_GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

1 formularios  
General Information
Descripción

General Information

Alias
UMLS CUI-1
C1508263
Centre Number
Descripción

Centre Number

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient Number
Descripción

Patient Number

Tipo de datos

text

Alias
UMLS CUI [1]
C1830427
Patient Initials
Descripción

Patient Initials

Tipo de datos

text

Alias
UMLS CUI [1]
C2986440
Visit Date
Descripción

Visit Date

Tipo de datos

date

Alias
UMLS CUI [1]
C1320303
STUDY CONCLUSION
Descripción

STUDY CONCLUSION

Alias
UMLS CUI-1
C1707478
UMLS CUI-2
C0008972
Did the patient complete the study according to the protocol?
Descripción

If ’No’, please mark the primary cause of withdrawal.

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1707478
UMLS CUI [1,2]
C0008972
UMLS CUI [1,3]
C2732579
Did the patient complete the study according to the protocol?
Descripción

If ’No’, please mark the primary cause of withdrawal.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1707478
UMLS CUI [1,2]
C0008972
UMLS CUI [1,3]
C2732579
UMLS CUI [1,4]
C0392360
Primary Cause - Other, specify:
Descripción

If ’No’, please mark the primary cause of withdrawal.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1707478
UMLS CUI [1,2]
C0008972
UMLS CUI [1,3]
C2732579
UMLS CUI [1,4]
C0392360
INVESTIGATOR SIGNATURE
Descripción

INVESTIGATOR SIGNATURE

Alias
UMLS CUI-1
C2346576
Investigator’s Signature
Descripción

Investigator’s Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C2346576
Date
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
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Similar models

Study Conclusion 26072_GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
General Information
C1508263 (UMLS CUI-1)
Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
text
C1830427 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Item Group
STUDY CONCLUSION
C1707478 (UMLS CUI-1)
C0008972 (UMLS CUI-2)
Study conclusion
Item
Did the patient complete the study according to the protocol?
boolean
C1707478 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C2732579 (UMLS CUI [1,3])
Item
Did the patient complete the study according to the protocol?
integer
C1707478 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C2732579 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
trial completion
Code List
Did the patient complete the study according to the protocol?
CL Item
Adverse experience (please complete AE page) (1)
CL Item
Insufficient therapeutic effect (2)
CL Item
Protocol deviation (including non-compliance) (3)
CL Item
Lost to follow-up (4)
CL Item
Other - specify (5)
trial completion cause other
Item
Primary Cause - Other, specify:
text
C1707478 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C2732579 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
Item Group
INVESTIGATOR SIGNATURE
C2346576 (UMLS CUI-1)
Investigator’s Signature
Item
Investigator’s Signature
text
C2346576 (UMLS CUI [1])
Date
Item
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Volver a la parte superior de la página 

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